Contemporary Hospital Outcomes Following Paediatric Cardiac Surgery in Patients With Trisomy 21 in Australia and New Zealand

Abstract

Background: To investigate whether trisomy 21 (T21) patients have worse early outcomes following paediatric cardiac surgery compared with non-T21 patients. Method: A binational paediatric cardiac surgery database (ANZCORS) was interrogated to identify patients with T21 between 2013 and 2021. Procedures were risk-stratified based on the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category. Primary outcomes were 30-day mortality, intensive care unit (ICU) and hospital length of stay. Secondary outcomes included all postoperative complications as defined in the European Congenital Heart Surgery Association database. Results: From 2013 to 2021, 254 of 8,298 (3%) patients were identified with T21. Median age was 121 days (IQR 76–398). Median weight was 4.9 kg (IQR 4.0–8.2). The most common procedure was atrioventricular septal defect repair (n=90, 31%). There were no patients with T21 in the highest risk STAT 5 category. No significant difference in 30-day mortality was found between T21 and non-T21 patients, regardless of the STAT category. Patients with T21 had a longer ICU stay in the lower risk STAT categories 1, 2, and 3 compared with non-T21 patients. Patients with T21 had a longer hospital stay in STAT categories 1 and 4 compared with non-T21 patients. Patients with T21 undergoing lower risk procedures (STAT 1 and 2) had a higher incidence of postoperative sepsis, pneumonia, and prolonged ventilation. Patients with T21 undergoing higher risk procedures (STAT 4) had a higher incidence of postoperative reintubation, chylothorax, infective endocarditis, and pericardial effusion needing drainage. Conclusion: Whilst there was no significant difference in 30-day mortality, median ICU stay was longer in T21 patients in the lower risk STAT categories. Patients with T21 had a higher incidence of postoperative complications.